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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/�ermits <br /> PROJECT SITE INFORMATION <br /> PRo��crA��Ress: 2521 Grand Ave <br /> BUILDING AREA(if residentiai,new construciion,remodel,or addition) SF <br /> BUILDING TYPE: �SFR-QETACHED ❑5FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMI�Y-#OF UNITS: ❑CRJMMERCIAL <br /> USE OF BUILDING: r@$IC�@Iltla� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRFCE OF WORK: $ 800 <br /> NUMBER OF DEVtCES if low volta e : <br /> FIRE ALARM? ❑YES ❑NO <br /> AS50CIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: add 20 am circuit for sump UITi� <br /> CONTACT INFORMATtON <br /> OWNER NAME: LeS LG'WIS TENANT NAME Ef Commercial : <br /> OWNER MAILING ADDRESS: srREer 2521 Grand Ave <br /> �,�. Everett ST„TE WA Z,F 9$201 <br /> dwr���PMONE: 425-269-7909 OWNEI2 EMAIL: <br /> CONTRACTOR NE1ME: BIaCIC LiOfi HEatltl & Air Conditionin <br /> CONTRACTOR ADDRESS: sTREEr����� ��$th P) N E <br /> CITY Kirkland STATE WA Z�F 98033 <br /> coNrRa;cTOR PHONe:425-814-3944 coNrRAcroR EMai�: brenda@blacklionhvac.com <br /> CONTRACTOR LfC.#�REQu�REo�: BLACKLH873QQ CITY OF EVERETT BUSINESS LIC.#(REQUIRED),�5354'� <br /> PRIMARY CONTACT: ❑OWNEft 0 CONTRACTOR ❑OTHER(P(ease Specify) <br /> CONTACT NAME: CONTACT PHONE: L�2�j$�43�4.L� <br /> Brenda CONTACT EMAIL:bC�tICI� blacklionhvac.com <br /> AGREEMENr:t herety cerfify that/have�ead and examined this applicatfon and know tho same to t�o true and correat. All provisions of/aws and ordinances goveming ihis type <br /> of work wilf be completecl whether specified herein nr not. The granting o!a permit does not presume to give authority to viotate or cance!the provrsiars cf any other state or <br /> tocel law regulating cnhstrucfiun ot the performance af construction. That 1 am authorized by the owner oi this property to pedorm the work for whlch appfiF.ation is made and l <br /> corrrply with the State�ontractors Law 18.27 RCW and 296.2Q0 WAC. <br /> J City of Evereff Offcial Use Only <br /> s <br /> � �� PERMIT# <br /> �-� � �_ � �- � �-� � �� E � ��2- 2z-3 <br /> Ow r/ horized p. nt a ure Date (Revised 9/23/2076) <br />